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The Happy, Healthy, City. A Dream or Tomorrow’s Reality?

Sweco experts examine our past and present to imagine a near future in which cities are hubs of health and happiness. Many urban environments are stressful and hazardous, they can be toxic environments detrimental to our health and climate. How can we transform our urban living spaces for the better?

Imagine a community where people are happy and lead long and fulfilling lives. A society where humankind, nature and technology are in balance and body and mind are in sync. Where we thrive, nature is abundant, and the resources of our planet are used and reused in an eternal loop. To most this ideal sounds like something to aim for in the countryside or the suburbs. But this is a future that we believe we can also imagine for our urban neighbourhoods. This could be our urban future.

In 2021, Sweco will focus the Urban Insight Program on Urban Health and Well-Being. We believe that urban health and well-being deserves our attention more than ever. 2020 taught us that there is still a lot to do to improve European and global health. Covid-19 together with the continuing increase in chronic diseases, lifestyle diseases and rapidly growing mental health problems shows us that there are still many health challenges facing society today.

This year, we focus on the contribution and effect our built environment has on urban health and well-being. We will focus on bringing together our knowledge of urban health and well-being and expanding our expertise by developing innovative solutions for urban communities. We strongly believe that a healthy and happy urban population is a precondition for a healthy, successful and future-proofed city.

Can we imagine an urban environment that builds health, that contributes radically to our well-being? Is this a future that is within our reach?

The Evolution of the Healthy City

Historically, early civilisations were founded in places that were safe and where water and food were available. They provided the conditions for prosperous communities where people took care of each other. Throughout history, urban settlements were the places where health innovation took place but as they grew they started to feel the impact of increased urban densification. Densification combined with unsanitary living conditions made cities vulnerable to health problems. Cities became breeding grounds for infectious diseases such as smallpox, dysentery, flu, typhoid, tuberculosis and cholera. Only around the turn of the 19th century did most governments in Europe actively implement policies and technological innovations such as sewage and clean water systems to improve urban health on a large scale. This led to a focus on healthy urban planning and healthy architecture that peaked in the 1950s.

With infectious diseases mostly under control and improved urban living conditions, the attention of urban health shifted towards healthcare infrastructure, providing cities with an intricate network of healthcare facilities, mostly focusing on the sick and elderly care. This increased life expectancy drastically. Recently, this attitude started to shift towards the future where health where prevention plays a more important role.

Ultimately, the future of health is not a hospital, it is a healthy city.

Bas Horsting, Design Director | Healthy Urban Living

An environment where well-being is the principal goal and where people look after each other. Although we have improved our living conditions, we believe that in Europe we have the tools and knowledge available to us to further radically improve our urban health and well-being. To take the next step to where the negative impacts of the urban environment are mitigated, and the densification and proximity inherent in our cities are valued and exploited. Where our urban lifestyle builds health and cities are recognized for their positive impact on health and well-being.

The city as a vaccine and health incubator

Throughout history we’ve seen that urban environments can often lead to unhealthy lifestyles. Today the effects of urbanisation is even seen as 1 of the top 10 causes of death including heart and lung disease, cancers and diabetes.

In Europe, chronic illnesses are by far the leading cause of mortality representing 86% of all deaths Between 168.000 and 346.000 premature deaths across the EU can be attributed to air pollution from fine particles alone. Moreover, air pollution causes about 600 billion EUR in economic and welfare losses annually across EU countries, equivalent to 4.9% of the GDP in 2017. Additionally, road traffic noise still is a big public health problem across many urban areas.
More than 100 million people in Europe are exposed to harmful levels of noise pollution and it has been calculated that in total one million healthy years of life are lost every year due to the effects of noise on health, including annoyance, sleep disturbance and heart disease. The urban environment is characterized by the presence of multiple stressors, with people in cities not only being more exposed to air pollution, noise and chemicals, but also having less access to green space and nature than people in rural environments.
European Environment Agency, 2020

Urban health will be a true challenge for future health if we continue the curative healthcare model.

By 2050, 70% of the world’s population will be living in towns and cities[ii]. It is also clear that the European population is ageing. The last years of our lives are spent chronic diseases fighting cardiovascular diseases, diabetes, cancer, chronic respiratory diseases, and mental health conditions. These are strongly linked to 5 big risk factors: tobacco use, harmful alcohol use, unhealthy diet, physical inactivity, and environmental problems[iii]. On top of that, in 2021, it also appears that patients with chronic diseases are more vulnerable to the COVID-19 virus. Cities and communities play a central role in the prevention of chronic diseases and the provision of healthy and safe spaces.

Do urban environments have the power to bend the curve and focus on prevention rather than curing diseases?

Another aspect of urban health is the problem of segregation and social inequalities; there are still large inequalities in life expectancy[iv][v], not only by gender but also by socioeconomic status. COVID‑19 mortality has a clear social gradient and reminds us of the importance of the social determinants of health: lower-income, people living in deprived areas and ethnic minorities have been disproportionately affected.

Can we address social inequalities through shaping our urban networks: resolving inequalities in mobility and access to public space, energy, food and water while taking future generations into account?

Besides our health, the health of our ecosystems is deteriorating. Contamination and pollution threaten our most valuable resources and climate change is accelerating each day. Touched upon by Urban Insight authors in 2020 urban health solutions are increasingly being linked to climate change solutions: applying nature for health, supporting circular societies and designing neighbourhoods for all are amongst the strategies in practice at Sweco.

Moving closer towards COP26 at the end of 2021, and the SDG’s by 2030, Europe is evaluating current climate strategies. We could be doing better. Can we accelerate the process and combine solutions? The question we want to tackle this year is one of integration, integrating solutions for our personal health and the health of our ecological ecosystems. The agenda of the EU Green deal is clearly choosing this path. Imagine a future without stress for people or climate.


The climate crisis is a health crisis. Healthy urban planning means planning for people. It promotes the idea that the city is much more than buildings, streets and open spaces, but a living, breathing organism, the health of which is closely linked to that of its citizens. WHO

Stress-free City Life? – Towards a mindful city

Urban stress suppressing the immune system

Living in a city can be stressful. Not only are we exposed to external factors such as pollution, noise and heavy traffic, but also mental strain is an issue. While living in the city, despite its dense population, many people feel lonely, depressed, anxious and afraid. All over the world, city dwellers are 40% more likely to suffer from depression and 20% from anxiety disorders[vi].

Urban stress is defined as “a state of bodily or mental tension developed through city living, or the physical, chemical, or emotional factors that give rise to that tension.”[vii]

Stress can be both positive and negative. We have all felt the rush of specific stress hormones in our body when we’ve run to catch that all-important train to the meeting we mustn’t miss. On arrival sweating, with a pounding heart and raised blood pressure, we feel momentarily elated. The body has gone into stress response mode. The physical reaction is the same for both negative and positive stress. But experiencing stress over time, has a negative effect of the body, as the immune system is suppressed, and the body is now focused on surviving instead of thriving. If the alarm state of stress continues over a longer period, we get exhausted, our body depleted, and it is not in a state where it can rest and repair itself easily. Then we can get ill.

How can we create a city environment that reduces instead of induces stress?

Urban stress is somehow built into our physical environment of the cities, then there must be a way to change our built environment for the better? How can we build and create communities that work as a health boost?

HEALTHY CITY: creative, alive, safe, urban nature…The more healthy people are, the more fun and creative lives they will live and thereby contribute to making the city a vibrant attractive place both to visit and to live in!


People cooperating, exchanging knowledge, ideas, friendship, workplaces, communities, people working better as a whole rather than as individuals. Cooperating, and not competing with each other.

Kristina Holmblad Senior Landscape architect, Sweco Norway

Tools to build a happy, resilient city

Nature-based – inclusive design

In our future cities, nature can provide a solution to stress, rising temperatures, localized flooding events and lack of overall biodiversity, which all affect our day-to-day well-being. The Covid-19 pandemic has shown that we cannot ignore our connection to nature, and not only in rural areas but in our cities too.

There is mounting evidence showing that nature and green open spaces alleviate our stress by calming us down. Several studies found that natural spaces are a major predictor of longevity and that integrating nature into the built environment through the use of nature-based solutions, for example in the form of open parks, swales, or green roofs, can help counter the stressors of busy urban life[ix][x]. Other study results found that office workers with forest views showed greater job satisfaction and lower stress levels than office workers with non-forest views[xi].

We see opportunities in using nature-based design in making cities healthier.


Can architectural and urban planning practices accomplish urban health and well-being through design without embracing big data, digitalization and technologization? Or is the practice entering a new paradigm? When, in the 1960s, social innovations were introduced by Modernists (e.g. Bauhaus), architectural practice started to include a sociological manifesto into the design question. Today we need radical changes and innovations in the light of health and climate change.  We see that architectural and planning practice are becoming more reliant on specific expertise and data. Will the integration of these technologies into design inspire the New Bauhaus that the European Commission is looking for?

As civilians leave digital traces everywhere, the opportunities to use data in the light of urban health and well-being are tremendous.

Is the data collected constantly from sensors, wearables, remote sensing, deep learning, monitoring and measuring applications becoming a safe and integrated design tool within reach for preventive health care and city planning?

The average package is better monitored than the average patient.
Koen Kas, health care futurist and author of the book Sick No More

Have information-driven technologies and a data-driven approach in the increasing complexity of cities become indispensable tools? In dismantling nuclear reactors, the use of a digital twin is certainly not only a nice-to-have, it saves lives. However, the use of digital tools can also be questioned. Knowing how to integrate health data safely and responsibly can teach the planning community how to proactively build preventive and healthy urban environments.

The value of urban health and well-being

The health of individuals has grown to be one of the most major policy concerns of today’s governments. General government expenditure in the EU on health amounted to EUR 944 billion or 7.0 % of GDP in 2018[xii]. Among the EU Member States, France, Germany and Sweden had the highest healthcare expenditure relative to GDP in 2017 (between 11.0% and 11.3%)[xiii].

Expectations are that this will grow significantly with an ageing population, since 90% of the cost of healthcare is spent in the last two years of life. Health spending is still overwhelmingly directed towards curative and rehabilitative care and pharmaceuticals, and only marginally on prevention. The percentage of health care expenditure reserved for prevention has been frozen in most countries around 2-3% [xiv] of the total healthcare expenditure although the return on investment is estimated much higher for prevention than for sickcare.

We cannot underestimate the value of prevention in the health condition of people. To maximise the potential of health improvement through prevention our investments in urban health should be guided by radical changes to the economic system. New economic models such as promoted by Kate Raworth’s doughnut economy and John Elkington’s Green Swans approach are leading the way to an economic model that is good for people and planet. We will investigate how new inclusive economic models can direct our approach to turning urban environments into productive health landscapes.

Urban Insight 2021 Urban Health & Well-Being

This year our knowledge platform will set the stage to highlight and discuss 3 sustainability areas in which Sweco can make a difference: healthy mobility, healthy buildings & cities and healthy water systems.  These areas represent the urban tissue in which the health and climate crisis can be tackled or mitigated by engineering and design practice.

It takes insight, bravery and dedication to together transform a society.

– Isabelle Putseys, Urban Insight Expert Lead

Healthy mobility

In 2018, the Urban Move theme discussed air quality, active travel and urban space for people on the move; all aspects that are directly related to our personal health. Building on that knowledge along with the lessons of Covid that revealed the flaws in our urban space, we relate the modal choice to social behaviour and the benefits of sharing space and sharing speed. The main report will focus on the self-propelled mobility systems, aspect of proximity and density to move towards socially sustainable communities. Creating more safe, healthy, social environments. Starting from our community, street, neighbourhood and region.

Healthy buildings and cities

In the themes Urban Energy (2019) and Climate Action (2020) we touched upon future energy storage, reduce & reuse, urban densification, climate resilience and biodiversity for climate and health. The messages from these reports are at the base for this topic of ‘healthy buildings and cities’: biophilic indoor and outdoor environments, re-naturalisation in the city, are the tools for more preventive planning in health care. Cities can be powerhouses (incubators), vaccines and medicines for health.

Healthy water systems

The urgency to reduce the exploitation of our scarce resources is the base of last year’s report on circularity. Building on this notion we want to highlight the challenges in water resource management, healthy water systems, restoring water landscapes, urban water circularity and water quality for our health and our ecosystem’s health.

Each of the three above mentioned areas will be featured in three separate dedicated reports, with expert insight from Sweco as well as external contributors.

As we launch the 2021 Urban Health and Well-Being theme, we also launch an open invitation to encourage collaboration with further organizations and experts. We share our knowledge via different media: reports, podcasts, educational platforms, seminars and social media. We offer you the opportunity to share your insights, or to use our platform to freely think about innovations and experiments in practice.


About the authors and contributors

Bas Horsting (1976) is a Dutch architect and urbanist, living and working in Amsterdam. His focus is on delivering innovative, spatial solutions to improve the health and sustainability of cities and communities worldwide. Bas strongly believes that the design of our built environment is a key contributor to a happy and healthy urban population.

Kristina Holmblad (1971) is a senior Landscape Architect forms part of the sustainable network Sweco Norway BLAB. She participates in creating a toolbox that will expand Sweco’s innovative skills on creating sustainable solutions.

Isabelle Putseys (1982) is 2021’s Urban Insights expert lead, responsible for the theme development of Urban Health & Well-being at the Urban Insight knowledge platform. She is advocating designerly multidisciplinary research with a focus on sustainability and climate resiliency of cities. She believes that interweaving engineering and urban design solutions even better can speed up that transition.

Contributing authors

Oscar Vercleyen is a bio-engineer who links his educational background in integrated ecosystem management and climate strategy to his passion for urban development and city planning. He works on various spatial planning studies and complex policy processes and is always enthusiastically looking for transition-oriented, sustainable and people-centred solutions.

Ishbel Campbell is an ecologist based in London, UK, with a passion for urban greening as part of building sustainability. Ishbel has experience in urban ecology and she aims to grow urban greening within urban design by working with clients and colleagues around the UK and Europe

Emma Sterner Oderstedt, Urban Insight Project Manager.
Antony Riley, Urban Insight Content Manager and Editor.

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